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Organization
TEXAS INSTITUTE OF PEDIATRICS PLLC
Active
Organization
TEXAS INSTITUTE OF PEDIATRICS PLLC
Active
Other names
Pediatric Specialists of Texas
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROBERTA S CLOUD (VICE PRESIDENT OF MANAGING MEMBER)
(210) 575-8500
Entity
Organization
Contact information
Practice address
4410 MEDICAL DRIVE, SUITE 540, SAN ANTONIO, TX 78229-3755
(210) 575-6240
(210) 575-6280
Mailing address
7711 LOUIS PASTEUR, STE 705, SAN ANTONIO, TX 78229-3415
(210) 575-7828
(866) 741-3697
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
2080P0203X
Pediatric Critical Care Medicine Physician
—
—
2080P0207X
Pediatric Hematology & Oncology Physician
—
—
2080P0214X
Pediatric Pulmonology Physician
—
—
2086S0120X
Pediatric Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A3121
MEDICARE
TX
05
—
197834803
—
TX
01
—
197834804
CSHCN
TX
Enumeration date
06/20/2008
Last updated
06/02/2009
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